局部晚期口鼻相关恶性肿瘤切除后的重建修复及并发症的处理

Rehabilitation&reconstruction and complication treatment to post-resection of local advanced oronasal malignant tumor

目的探讨局部晚期口鼻相关恶性肿瘤的修复重建及术后并发症处理的应用价值。方法回顾性分析原发于鼻腔鼻窦,硬腭及上颌牙槽的局部晚期口鼻恶性肿瘤33例,继发口腔癌术后复发病例侵犯口鼻恶性肿瘤3例,病理类型主要为鳞癌和小涎腺恶性肿瘤。术前CT和MRI检查,所有病例肿瘤均不同程度破坏鼻腔鼻窦,上腭,眶周,颅底区域,根据病情采用不同手术入路完整切除病灶后,采用游离股前外侧皮瓣,游离腓骨肌皮瓣及钛网等修复方法重建缺损并随访疗效及并发症。结果所有病例均成功切除肿瘤,一期重建均成功,皮瓣成活,外形恢复可,无明显口鼻瘘,脑脊液瘘,眶底及面部塌陷。术后中位随访期12个月,出现咽鼓管闭塞中耳积液8例,鼻泪管溢泪5例,吞咽障碍6例。结论手术切除是口鼻相关恶性肿瘤的一种有效治疗方法,一期修复重建及积极处理并发症对改善患者外形及生活质量具有重要意义,对术后的综合治疗提供了便利。

Objective To explore the value of rehabilitation&reconstruction and complication treatment to post-resection of local advanced oronasal malignant tumor.Methods A retrospective analysis of 33 primary oronasal malignant tumors and 3 secondary oronasal malignant tumors sourcing from recurrence of oral malignant tumors was performed.The major pathological types were squamous cell carcinoma and malignant minor salivary gland tumor.Preoperative CT(Computed Tomography)and MRI(Magnetic Resonance Imaging)scan showed that the tumors in all patients invaded the nasal cavity and sinuses,peri-orbit or skull base in varying degrees.The lesion was completely resected using different surgical approaches according to the condition and the defected area was rehabilitated and reconstructed by using free thigh anterolateral flap,free fibula myocutaneous flap,and titanium net,while curative effect and complication were followed up.Results All the cases were Enbloc resection,and the first phase rehabilitation&reconstruction was successful.The appearance of the patients was ideal and the complication of oronasal fistula,cerebrospinal fluid fistula,orbit floor collapse,and face collapse didn’t happen.The median follow-up period was 12 months,8 cases of Eustachian tube obstruction,5 cases of epiphora,and 6 cases of swallowing disability happened.Conclusion Surgical resection is an effective method the oronasal malignant tumors.The first phase rehabilitation&reconstruction and complication treatment will do good to patients’appearance and life quality,meanwhile,which affords convenience to synthetic treatment after the operation.